Well, now that she's passed away, there's no shortage of coverage of Nataline's case, the child who died because of delays in okaying insurance coverage for her transplant.
As I have stated before, insurers use the traditional out: We don't say don't get the medical care, we just say we won't cover it. Don't be distracted from the core issues. But as I watch the parade of grieving, outraged, conciliatory responses to the event, I have to wonder about the other players.
First: Media coverage: While the world got involved in the treatment of the decade long comatose patient Terry Schivo BEFORE the plug was pulled, news coverage of Nataline's case was minimal before her death. Perhaps the sensationalist, and marketability of religion wasn't clear enough in this case for any one to really pay attention. EVERY DAY a media concerned about lives lost because of insurance-related events would be part of the news reported to us if insurance reform goals were anywhere near the top of audience-getting. Not sexy enough.
Second: Especially this time of year, we hear all the wonderful and heartwarming stories about physicians and hospitals performing surgeries for free on people who otherwise would not have a chance at medical care. THIS DOES NOT BEGRUDGE the individuals who benefit from such donations, it only brings up the issue: How do you get that donation? Is it only for non-citizens such as the Iraqi child injured in war or the attached twins from some other place? The hospital and doctors could have performed this surgery for free--.
Third: Why did the family not go ahead with the surgery and fight CIGNA later? I and others have advised--never delay care based on insurance coverage delays.
Fourth: Now to CIGNA. That's my insurer too. This year all insureds are "EMPOWERED" to choose worse plans to save money (such as high deductibles) but "WELLNESS" credits for going to the gym will save you $150 a year.
EXPERIMENTAL: From what has been released, the non-coverage for the transplant was based on survival statistics that rendered the transplant "experimental". This argument is grotesque in many ways and is not honest in one specific way. Most hospital fees include charges for "research"--the money charged to patients includes these fees. Patients submit their claims to insurance companies and hospitals are paid by insurance companies--including those charges. RESEARCH? By definition research involves trial and error, hypothesis and testing of hypothesis, in other words EXPERIMENT. Perhaps those funds should be withdrawn from hospitals and used for insureds who are paying premiums for coverage?
Today every CIGNA insured loses and mourns the death of Nataline for her own sake and because it could easily be each of us. While her lawsuit is also "EXPERIMENTAL" because insurers have often been able to opt out of responsibility, we should applaud the fact that it is being filed. I only believe it should include the hospital as well (were services denied because the patient was uninsured?) the doctors (were lifesaving actions withheld based on insurance coverage?) and the parents (did they withhold their consent for surgery until they knew they'd get coverage?).
